PAEA GENERAL SURGERY EOR EXAM
LATEST ACTUAL EXAM QUESTIONS WITH
VERIFIED DETAILED ANSWERS (GRADED
A+)
A patient with peritonitis secondary to a ruptured appendix was
admitted to the intensive care unit with hypotension and
tachycardia. Which of the following crystalloid solutions would be
recommended for the fluid resuscitation of this patient?
(A) 5% Dextrose water
(B) 5% Dextrose water with 0.45% sodium chloride
(C) 0.9% Sodium chloride
(D) Lactated Ringer's solution Correct Answer (D) Third-space
fluid losses that occur with inflammatory conditions such as
peritonitis result in an isotonic volume depletion; the
recommended intravenous fluid used to replace those losses is
lactated Ringer's solution, which is a balanced salt solution that
contains 130 mEq/L of sodium, 109 mEq/L of chloride, 4.0 mEq/L
of potassium, 3.0 mEq/L of calcium, and 28 mEq/L of lactate.
A patient is admitted to the intensive care unit in hypovolemic
shock secondary to a splenic injury sustained in a motor vehicle
collision. What is the most objective means of assessing that the
intravascular volume is being adequately replaced during fluid
resuscitation?
(A) Measurement of patient weight
(B) Maintenance of urinary output
(C) Resolution of orthostatic changes
(D) Normalization of peripheral perfusion Correct Answer (B) The
most objective means of assessing the adequacy of volume
replacement for fluid losses is by following the urinary output,
which should be at a minimum of 0.5 mL/kg/h. Other objective
measures include normalization of hemoglobin and hematocrit
,values as well as BUN and creatinine levels. Following the patient
weight as well as intake and output can provide valuable
information about the patient's volume status over time.
What is the most appropriate step following the placement of a
nasoenteric feeding tube?
(A) Obtain a radiograph
(B) Check position of the tube by instillation of air
(C) Instill sterile saline prior to tube feedings
(D) Check gastric residuals Correct Answer (A) The use of
nasoenteric feeding is usually reserved for patients who have an
intact mental status examination and have intact protective
aspiration reflexes. All tubes that are placed for feeding must be
verified by a radiograph. The instillation of air is inaccurate to
document position of nasoenteric feeding tubes. After a
radiograph is obtained, the results should be documented in the
chart prior to the start of tube feedings.
A 23-year-old man, unrestrained driver, is brought to the
emergency department by ambulance after having been involved
in an automobile accident. His vitals are BP: 99/54 mm Hg, P:
112/min, R: 18/min, oxygen saturation: 99%, T: 99.8°F.
Examination reveals mild abdominal tenderness with pain
radiating to the right shoulder. What is the most appropriate
diagnostic test to order initially?
(A) Computed tomography of the abdomen and pelvis
(B) Diagnostic peritoneal lavage
(C) Flat and upright abdominal radiographs
(D) Diagnostic ultrasound Correct Answer (D) The initial
evaluation of blunt abdominal trauma is by the performance of a
FAST (focused assessment with sonography for trauma)
ultrasound, which is performed by an emergency department
physician or surgeon. CT scan remains an adjunct test in
hemodynamically stable patients or in patients in whom further
assessment of solid intra-abdominal organs is required.
,Which of the following treatment options is recommended for a
patient with a grade I splenic laceration on CT scan who is
otherwise hemodynamically stable?
(A) Exploratory laparotomy and splenectomy
(B) Exploratory laparotomy and splenorrhaphy
(C) Exploratory laparotomy and partial splenectomy
(D) Nonoperative management with splenic preservation
(E) Splenic autotransplantation into the omentum Correct Answer
(D) Nonoperative management in hemodynamically stable
patients with splenic injuries is preferred. This modality of therapy
avoids a laparotomy and its associated complications and
preserves splenic function. Although infections postsplenectomy
with encapsulated bacteria are more common in the pediatric age
group, in immunocompromised adults, they are nevertheless a
concern.
Which of the following interventions is recommended to promote
wound healing for this patient?
(A) Vitamin A
(B) Vitamin C
(C) Zinc replacement
(D) Hyperbaric oxygen Correct Answer (A) *Vitamin A* in doses
of 25,000 IU orally is helpful for patients who have thin, *fragile
skin secondary to chronic steroid therapy*. *Vitamin C and zinc*
are helpful for patients with *poor nutrition*; hyperbaric oxygen
may be helpful for chronic wounds.
Which of the following type of gallstones is the most common in
the United States?
(A) Mixed
(B) Calcium
(C) Brown pigmented
(D) Black pigmented Correct Answer (A) Approximately 75% of
the gallstones found in Western civilization are of the mixed
, variety. The mixed variety contains cholesterol and calcium. Most
of the mixed stones do not contain enough calcium to be
appreciated on plain films. Black-pigmented stones account for
20% of the stones and are often associated with hemolysis and
cirrhosis. Brown-pigmented stones are most commonly
associated with infected bile.
Which population has the highest incidence of gallstones in the
United States?
(A) Caucasian women older than 50 years
(B) Hispanic men older than 50 years
(C) African American men younger than 50 years
(D) Native American women before the age of 60 years Correct
Answer (D) Native Americans have the highest incidence of
gallstones. By the age of 60 years, the Native American male
runs a rate of 50%, whereas the female of the same age and
population will develop gallstones 80% of the time. The
prevalence rate in white females younger than 50 years is 5% to
15%, and for those older than 50 years, the prevalence rate is
25%. For white males younger than 50 years, the prevalence rate
is 4% to 10%, and for those older than 50 years, it is 10% to 15%.
A 52-year-old woman presents with the acute onset of right upper
quadrant pain that is associated with fever, nausea, and vomiting.
Which of the following best describes the underlying pathology
associated with her diagnosis?
(A) Intermittent obstruction of the cystic duct without inflammation
(B) Sustained obstruction of the cystic duct with inflammation
(C) Obstruction of the common bile duct without inflammation
(D) Obstruction of the common bile duct with inflammation Correct
Answer (B) The case described is consistent with acute
cholecystitis that results from sustained obstruction of the cystic
duct from cholelithiasis resulting in right upper quadrant (RUQ)
pain, fever, and leukocytosis. Biliary colic is characterized by
intermittent obstruction without inflammation resulting in
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